Provider Demographics
NPI:1194835272
Name:HISLOP, JAMES MARLOW (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MARLOW
Last Name:HISLOP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 ROUTE 146
Mailing Address - Street 2:STE 210
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-577-8367
Mailing Address - Fax:518-280-1893
Practice Address - Street 1:939 ROUTE 146
Practice Address - Street 2:STE 210
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-577-8367
Practice Address - Fax:518-280-1893
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0194001104100000X
NYPR019400-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02846591Medicaid